Test-based exclusion diets in gastro-esophageal reflux disease patients:A randomized controlled pilot trial

AIM:To investigate the clinical response of gastroesophageal reflux disease(GERD)symptoms to exclusion diets based on food intolerance tests.METHODS:A double blind,randomized,controlled pilot trial was performed in 38 GERD patients partially or completely non-responders to proton pump inhibitors(PPI)treatment.Fasting blood samples from each patients were obtained;leukocytotoxic test was performed by incubating the blood with a panel of 60food items to be tested.The reaction of leukocytes(rounding,vacuolization,lack of movement,flattening,fragmentation or disintegration of cell wall)was then evaluated by optical microscopy and rated as follows:level 0=negative,level 1=slightly positive,level 2=moderately positive,and level 3=highly positive.A"true"diet excluding food items inducing moderatesevere reactions,and a"control"diet including them was developed for each patient.Then,twenty patients received the"true"diet and 18 the"control"diet;after one month(T1)symptoms severity was scored by the GERD impact scale(GIS).Hence,patients in the"control"group were switched to the"true"diet,and symptom severity was re-assessed after three months(T2).RESULTS:At baseline(T0)the mean GIS global score was 6.68(range:5-12)with no difference between"true"and control group(6.6±1.19 vs 6.7±1.7).All patients reacted moderately/severely to at least 1 food(range:5-19),with a significantly greater number of food substances inducing reaction in controls compared with the"true"diet group(11.6 vs 7.0,P<0.001).Food items more frequently involved were milk,lettuce,brewer’s yeast,pork,coffee,rice,sole asparagus,and tuna,followed by eggs,tomato,grain,shrimps,and chemical yeast.At T1 both groups displayed a reduction of GIS score("true"group 3.3±1.7,-50%,P=0.001;control group 4.9±2.8,-26.9%,P=0.02),although the GIS score was significantly lower in"true"vs"control"group(P=0.04).At T2,after the diet switch,the"control"group showed a further reduction in GIS score(2.7±1.9,-44.9%,P=0.01),while the"true"group did not(2.6±1.8,-21.3%,P=0.19),so that the GIS scores didn’t differ between the two groups.CONCLUSION:Our results suggest that food intolerance may play a role in GERD symptoms development,and leucocytotoxic test-based exclusion diets may be a possible therapeutic approach when PPI are not effective or indicated.

24-hour esophageal pH-monitoring in children suspected of gastroesophageal reflux disease: Analysis of intraesophageal pH monitoring values recorded in distal and proximal channel at diagnosis

AIM: To assess values of 24-h esophageal pH-monitoring parameters with dual-channel probe (distal and proximal channel) in children suspected of gastroesophageal reflux disease (GERD). METHODS: 264 children suspected of gastroesophageal reflux (GER) were enrolled in a study (mean age χ = 20.78 ± 17.23 mo). The outcomes of this study, immunoallerrgological tests and positive result of oral food challenge test with a potentially noxious nutrient, enabled to qualify children into particular study groups. RESULTS: 32 (12.1%) infants (group 1) had physiological GER diagnosed. Pathological acid GER was confirmed in 138 (52.3%) children. Primary GER was diagnosed in 76 (28.8%) children (group 2) and GER secondary to allergy to cow milk protein and/or other food (CMA/FA) in 62 (23.5%) children (group 3). 32 (12.1%) of them had CMA/FA (group 4-reference group), and in remaining 62 (23.5%) children neither GER nor CMA/FA was confirmed (group 5). Mean values of pH monitoring parameters measured in distal and proximal channel were analyzed in individual groups. This analysis showed statistically significant differentiation of mean values in the case of: number of episodes of acid GER, episodes of acid GER lasting > 5 min, duration of the longest episode of acid GER in both channels, acid GER index total and supine in proximal channel. Statistically significant differences of mean values among examined groups, especially between group 2 and 3 in the case of total acid GER index (only distal channel) were confirmed. CONCLUSION: 24-h esophageal pH monitoring confirmed pathological acid GER in 52.3% of children with typical and atypical symptoms of GERD. The similar pH-monitoring values obtained in group 2 and 3 confirm the necessity of implementation of differential diagnosis for primary vs secondary cause of GER.

机械通气患者中三种鼻饲方法所致食物返流率的比较

目的比较灌注、泵注和滴注三种不同鼻饲方法在机械通气患者中所致的食物返流发生率 ,以寻求机械通气患者中比较安全的鼻饲方法。方法 6 0例需要行胃肠内营养和机械通气的患者随机行灌注、泵注和滴注法鼻饲 ,三种方法分别为 1 32次、1 35次、4 5次 ,共完成 31 2次。结果灌注、泵注和滴注法鼻饲所致的食物返流发生率分别为 1 5 %、2 .9%、6 % ,其中泵注组食物返流发生率显著低于其它两组 (χ2 =1 5 0 ,P <0 .0 1 )。结论对于机械通气患者实行胃肠内营养时 ,泵注法比灌注法和滴注法安全。

利用餐厨垃圾循环半连续厌氧发酵产氢研究

利用餐厨垃圾采用半连续厌氧发酵进行产氢的研究.实验结果表明以高温(100 ℃)预处理15 min的厌氧活性污泥为种泥,在温度37 ℃,pH 6.0左右, 较宽的稀释率(1.0～4.0 d-1)范围内,均能较好的实现厌氧发酵产氢.在稀释率D=2.4 d-1下,流出液中乙醇、乙酸 、丙酸、丁酸和戊酸的质量分数分别为5.6%、29.6%、5.4%、58.5%和0.9%,产氢过程属于典 型的丁酸型发酵,最终氢气的体积分数可达60%,氢气的产生速率为5.49 m3/(m 3 ·d).将厌氧发酵液相产物作为稀释液返回到反应器中,反应器的产氢能力大幅度的提高 ,当回流比 R=0.8时,最大产氢速率可达10.9 m3/(m3·d),最终氢气的含量可达 65%,厌氧发酵反应器的产氢能力提高了约130%.

嗜酸细胞食管炎研究进展

由于嗜酸细胞食管炎(eosinophilic esophagitis,EE)的发病率逐年升高,因此越来越引起国内外医师的重视.近年来关于EE发病机制、病理生理表现、诊断及有效治疗方法的研究越来越多,本文就以上诸多问题的研究进展作一综述.

废弃食品回流再造问题的产品价格分析

针对废弃食品回流再造的食品安全问题,建立相关利益主体包括食品制造商、废弃食品收购者在各自独立以及作为利益共同体的不同条件下的优化模型,分析新生产食品价格和回流再造食品价格以及相应的利润、影响因素.结果表明:作为同一利益主体,生产制造昂贵食品对食品制造商获利不利,而回流再造成本越低,对食品制造商通过回流再造获利是有利的;若食品制造商和收购者各自独立决定价格,收购者进行回流再造的行为会干扰当前食品零售市场;由于回流再造食品的价格比较优势,在信息不对称时消费者会倾向选择回流再造食品.

睡前进食对夜间胃食管反流的影响

目的胃食管反流的发病与多种因素有关，其中不良饮食习惯是重要的诱发因素之一。该文试图通过分析夜间食管pH检测的各项参数，探讨睡前进食对夜间胃食管反流的影响。方法进行24h胃食管反流监测的38例患儿，根据睡前2h内是否进食分为进食组（A组n=16），未进食组（B组，n=22）。比较两组夜间反流次数、最长反流时间、持续时间〉5min的反流次数和pH〈4的时间百分比。结果A，B两组各项检测参数分别为①夜间总反流次：32（21.5—43.5）和24（15—37.3）次；②最长反流时间：6.6（2．4～29.8）min和4.5（2．5—13.2）min；③持续时间〉5min的反流次数：1．5（0—3）和0（0～3）次；④pH〈4的时间百分比：4.3％（2.1％～15．0％）和4．1％（2．0％～7．2％），两组比较均P〉0．05，差异均无显著性。结论睡前非刺激性饮食对夜间反流无明显作用。

食管屏障功能和胃食管反流病

正常生理状态下食管黏膜和食管黏膜分泌的黏液能抵抗胃酸、胆盐及其他化学物质的损害,起到重要的屏障作用。食管的正常运动也是重要的食管屏障作用保护机制之一。许多刺激性的食物、药物都会影响食管的屏障功能,对这一领域的许多问题仍有待进一步的研究。

有机负荷与回流比对餐厨垃圾两相厌氧消化的影响

【目的】研究产甲烷相的有机负荷与沼液的不同回流比在餐厨垃圾两相厌氧消化过程中对产酸和产气的影响。【方法】以餐厨垃圾为原料,采用两相厌氧消化工艺,分别设置了不同的有机负荷与回流比,考察两者对两相厌氧消化产酸和产气的影响。【结果】沼液回流可以提高产酸相的pH,促进餐厨垃圾酸化,在产酸相有机负荷(以挥发性固体物含量计,下同)为11.33 g·L^(–1)·d–1时,回流比为10%、30%和50%处理的挥发性脂肪酸(VFA)质量浓度分别为11 598.48、12 998.41和14 967.64 mg·L^(–1),比空白处理(CK)分别提高了9.06%、22.23%和40.74%;在沼液不回流时,产甲烷相的最适有机负荷为6.38 g·L^(–1)·d–1,当负荷提高至8.50 g·L^(–1)·d–1时,系统出现了酸抑制现象,而回流比为50%时,可以提高系统的缓冲性,维持系统的稳定;回流比50%处理的平均负荷产气量(以挥发性固体物含量计)为486.14 mL·g^(-1),比CK、回流比10%和30%处理分别提高了29.84%、20.80%和9.13%。【结论】餐厨垃圾两相厌氧消化过程中,沼液不回流时,产甲烷相的最适有机负荷为6.38 g·L^(–1)·d–1;继续提高有机负荷,系统会产生酸抑制现象;当沼液回流比为50%时,产甲烷相的最适有机负荷可以提高至8.50 g·L^(–1)·d–1,系统可以保持稳定运行。

不同连续性空肠间置代胃术用于胃癌根治术的效果观察

目的观察不同连续性空肠间置代胃术（CJI）用于胃癌根治术的效果，探讨应用CJI的适应证。方法根据胃全切除或次全切除后的具体情况，45例胃癌患者在根治术中采用CJI重建消化道，空肠分别被间置于食管和十二指肠之间（A组15例）、食管和远端残胃之间（B组14例）以及近端残胃和十二指肠之间（C组16例）。观察患者术后半年内营养指标的变化（包括体重、血红蛋白、血浆总蛋白和前白蛋白）和进食的情况（包括每El进食次数、每次进食量），并作内镜检查观察是否有反流性食管炎的发生。结果A、C两组患者术后6个月时各营养指标均有改善，并以C组最明显（P〈0．05）。3组患者的进食情况以C组最佳，而反流性食管炎在A、B两组中的发生率较高，尤其是B组（P=0．000）。结论CJI虽然使胃癌患者在根治术后的食物通路更符合生理，但在消化道重建时并非总是最佳的选择，应提倡根据术中的具体情况个体化应用CJI。

餐厨垃圾厌氧消化系统运行恢复实验分析

餐厨垃圾中温(36±1)℃干式厌氧消化由于系统含水率不断升高而最终导致运行失败,在保持相同的运行条件下,对进料含水率为82%的餐厨垃圾采取停料调节为主沼渣回流为辅的方式对运行失败的厌氧消化系统进行了系统活性恢复实验研究。监测并分析了整个实验过程中产气量、p H、VFA、碱度和消化液含水率等能够反应厌氧消化系统性能的指标。经过大约26 d的调节,将干式厌氧消化系统内的含水率、VFA分别控制在86.70%~87.73%、9 458~10 778 mg/L之间的平稳状态,并得到较高的产气率61 L/d。调节手段起到了预期的作用,系统获得良好的恢复效果。

回流消化技术在测定食品蛋白质含量中的应用

目的:了解回流消化技术在食品蛋白质含量测定中的应用效果。方法:采用自动回流消化仪替代国标法蛋白质测定中使用凯氏定氮烧瓶进行消化的方法。由于样品与试剂的反应是在相对密闭的容器内进行,所以在消化过程中分解产生的大量酸雾、硫的氧化物等刺激性气体溶于冷凝水中排出,对环境的污染和对分析人员毒害大大减小。结果:实验结果表明,回流消化法与国标法比较,测定结果基本一致,t检验无显著性差异(P>0.05),测定样品蛋白质含量在1.59%～23.55%之间的相对标准偏差(RSD)为0.64%～1.96%(n=5),平均回收率为98.3%。结论:自动回流消化法仪器价格便宜,不需要消毒通风柜,可节约经费开支,消化时间较为缩短,减轻了分析人员的劳动强度,相对提高了工作效率。对基层卫生检验实验室具有一定的推广应用价值。

我国不同管饲方式下脑卒中病人胃肠并发症发生情况的Meta分析

[目的]系统评价鼻空肠管与鼻胃管喂养方式下脑卒中病人胃肠并发症的发生情况。[方法]计算机检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、数字化期刊全文数据库(万方)、中文科技期刊数据库(VIP)中有关经鼻空肠管喂养与鼻胃管喂养脑卒中病人胃肠并发症发生情况的随机对照试验,运用RevMan5.3对符合纳入标准的文献进行Meta分析。[结果]共纳入8篇文献,合计样本量550例。Meta分析结果显示:脑卒中病人行肠内营养支持时,采用鼻空肠管喂养能够降低腹胀发生率[OR=0.11,95%CI(0.04,0.29),P<0.01]、腹泻发生率[OR=0.45,95%CI(0.27,0.75),P=0.002]、呕吐发生率[OR=0.10,95%CI(0.04,0.22),P<0.01]以及食物反流发生率[OR=0.14,95%CI(0.08,0.25),P<0.01]。[结论]脑卒中病人行肠内营养支持时,如病人的胃肠功能未受损,建议优先选择鼻空肠管喂养,以更好地改善疾病预后。

药食同源材料组合中二氢杨梅素水提工艺优化

目的:通过对药食同源材料组合(藤茶30%、桑叶15%、菊花15%、芦根10%、麦芽10%、甘草10%和淡竹叶10%)中二氢杨梅素进行提取工艺优化,为药食同源材料开发及浸膏粉的生产提供参考。方法:先对提取次数进行考察,再以浸泡时间、加水量和提取时间为影响因素,在单因素试验的基础上,采用L_(9)(3^(4))正交表进行正交试验,优化水提法提取药食同源材料组合中二氢杨梅素的条件。结果:加水量对药食同源材料组合中二氢杨梅素提取量和浸膏得率具有显著影响(P<0.05),综合考虑生产的成本、时效性与稳定性,水提工艺的最优条件为加水浸泡0.5 h,提取2次,第1次加水体积为其质量的10倍提取1.5 h,第2次加水体积为其质量的8倍提取1.0 h。在最佳条件下,65 g药食同源材料组合中二氢杨梅素提取量为3761.14 mg,浸膏得率为31.42%。结论:热水回流提取法可作为药食同源材料组合的提取方法,此法简单可行,效率高,结果准确,可用于药食同源材料组合中二氢杨梅素的提取工艺优化研究。

Is the schatzki ring a unique esophageal entity?

AIM:To study,whether the association of Schatzki rings with other esophageal disorders support one of the theories about its etiology.METHODS:From 1987 until 2007,all patients with newly diagnosed symptomatic Schatzki rings (SRs) were prospectively registered and followed.All of them underwent structured interviews with regards to clinical symptoms,as well as endoscopic and/or radiographic examinations.Endoscopic and radiographic studies determined the presence of an SR and additional morphological abnormalities.RESULTS:One hundred and sixty-seven patients (125 male,42 female) with a mean age of 57.1±14.6 years were studied.All patients complained of intermittent dysphagia for solid food and 113 (79.6%) patients had a history of food impaction.Patients experienced symptoms for a mean of 4.7±5.2 years before diagnosis.Only in 23.4% of the 64 patients who had endoscopic and/or radiological examinations before their first presentation to our clinic,was the SR previously diagnosed.At presentation,the mean ring diameter was 13.9±4.97 mm.One hundred and sixty-two (97%) patients showed a sliding hiatal hernia.Erosive reflux esophagitis was found in 47 (28.1%) patients.Twenty-six (15.6%) of 167 patients showed single or multiple esophageal webs;five (3.0%) patients exhibited eosinophilic esophagitis;and four (2.4%) had esophageal diverticula.Four (7%) of 57 patients undergoing esophageal manometry had nonspecific esophageal motility disorders.CONCLUSION:Schatzki rings are frequently associated with additional esophageal disorders,which support the assumption of a multifactorial etiology.Despite typical symptoms,SRs might be overlooked.

鼻饲置管深度及体位摆放对神经外科气管切开鼻饲饮食患者食物反流的影响

目的探讨鼻饲置管深度及体位摆放对神经外科气管切开鼻饲饮食患者食物反流的影响。方法选择2016年2月~2019年2月我院收治的60例气管切开鼻饲饮食患者作为研究对象,根据随机数字表法分为对照组与观察组,各30例。对照组鼻饲置管深度为50cm左右,取常规仰卧位;观察组在对照组的基础上鼻饲置管深度增加10~15cm,采取头高脚低30°~60°斜坡卧位。比较两组患者置管后不同时间内的胃残留量及不良事件总发生率。结果鼻饲置管30、60、120min后,观察组的胃残留量少于对照组,不良事件总发生率低于对照组,差异有统计学意义(P<0.05)。结论气管切开鼻饲饮食患者进行鼻饲时鼻饲置管深度增加10~15cm并采用头高脚低30°~60°斜坡卧位可加速胃排空,降低吸入性肺炎、食物反流、呛咳及误吸等不良事件发生率,促进患者转归。

Dysphagia: Thinking outside the box

Dysphagia is a common symptom that is important to recognise and appropriately manage, given that causes include life threatening oesophageal neoplasia, oropharyngeal dysfunction, the risk of aspiration, as well as chronic disabling gastroesophageal reflux(GORD). The predominant causes of dysphagia varies between cohorts depending on the interplay between genetic predisposition and environmental risk factors, and is changing with time. Currently in white Caucasian societies adopting a western lifestyle, obesity is common and thus associated gastroesophageal reflux disease is increasingly diagnosed. Similarly, food allergies are increasing in the west, and eosinophilic oesophagitis is increasingly found as a cause. Other regions where cigarette smoking is still prevalent, or where access to medical care and antisecretory agents such as proton pump inhibitors are less available, benign oesophageal peptic strictures, Barrett's oesophagus, adeno-as well as squamous cell carcinoma are endemic. The evaluation should consider the severity of symptoms, as well as the pretest probability of a given condition. In young white Caucasian males who are atopic or describe heartburn, eosinophilic esophagitis and gastroesophageal reflux disease will predominate and a proton pump inhibitor could be commenced prior to further investigation. Upper gastrointestinal endoscopy remains a valid first line investigation for patients with suspected oesophageal dysphagia. Barium swallow is particularly useful for oropharyngeal dysphagia, and oesophageal manometry mandatory to diagnose motility disorders.

基于大数据平台分析影响南京市孝陵卫地区胃食管反流病患病的危险因素

目的通过大数据平台分析影响南京市孝陵卫地区胃食管反流病(GERD)患病的危险因素。方法从胃食管反流病健康大数据管理平台随机抽取100例病例,GERD患者50例,为病例组;非GERD患者50例,为对照组。运用单因素分析及二元Logistic回归分析影响南京市孝陵卫地区人群GERD患病的危险因素。结果单因素分析结果显示,病例组的吸烟、饮酒、偏嗜高脂肪食物患者占比高于对照组(P<0.05)。Logistic回归分析结果显示,偏嗜高脂肪食物是影响该地区人群GERD患病的独立危险因素(P<0.05)。结论南京市孝陵卫地区人群GERD患病与偏嗜高脂肪食物相关。

不同吸痰方法防止脑卒中机械通气患者食物反流的效果比较

目的比较两种吸痰方法防止脑卒中机械通气患者食物反流的效果。方法选取26例脑卒中机械通气患者为研究对象，采取自身对照法，单日采用试验吸痰法，双日采用常规吸痰法，比较两种方法食物反流次数。结果试验吸痰法的反流率为7．0％，低于常规吸痰法的反流率13．7％，差异有统计学意义（x2=11．24，P〈0．05）。结论对于脑卒中机械通气患者采用试验吸痰法可以减少食物的反流率，从而减少吸人性肺炎的发生，有利于患者的康复。

超声辅助乙醇回流提取冬凌草抑菌活性成分的工艺优化

冬凌草具有显著的抗菌活性,是一种能够抑制食品有害菌的良好资源,从其中提取天然食品防腐剂具有广阔的应用前景。对超声辅助乙醇回流提取冬凌草抑菌活性成分的工艺进行研究,以金黄色葡萄球菌为供试菌,考察了乙醇体积分数、超声功率、提取温度、料液比和提取时间对冬凌草抑菌活性物质提取的影响。在此基础上,选取超声功率、提取温度和提取时间3个因素进行响应面优化,获得的最优提取工艺条件为:乙醇体积分数为95%、超声功率200W、提取温度62℃、提取时间44 min、料液比1:25 g/mL。在此优化条件下,冬凌草提取物对金黄色葡萄球菌的抑菌圈直径达到28.89 mm。对5种食品致腐致病菌抑菌试验结果显示,冬凌草提取物显示出较好抑菌效果。